• Andrew J Karter, Melissa M Parker, Howard H Moffet, Kasia J Lipska, Neda Laiteerapong, Richard W Grant, Catherine Lee, and Elbert S Huang.
• Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA. Andy.j.karter@kp.org.
• J Gen Intern Med. 2023 Oct 1; 38 (13): 286028692860-2869.

BackgroundEstimated life expectancy for older patients with diabetes informs decisions about treatment goals, cancer screening, long-term and advanced care, and inclusion in clinical trials. Easily implementable, evidence-based, diabetes-specific approaches for identifying patients with limited life expectancy are needed.ObjectiveDevelop and validate an electronic health record (EHR)-based tool to identify older adults with diabetes who have limited life expectancy.DesignPredictive modeling based on survival analysis using Cox-Gompertz models in a retrospective cohort.ParticipantsAdults with diabetes aged ≥ 65 years from Kaiser Permanente Northern California: a 2015 cohort (N = 121,396) with follow-up through 12/31/2019, randomly split into training (N = 97,085) and test (N = 24,311) sets. Validation was conducted in the test set and two temporally distinct cohorts: a 2010 cohort (n = 89,563; 10-year follow-up through 2019) and a 2019 cohort (n = 152,357; 2-year follow-up through 2020).Main MeasuresDemographics, diagnoses, utilization and procedures, medications, behaviors and vital signs; mortality.Key ResultsIn the training set (mean age 75 years; 49% women; 48% racial and ethnic minorities), 23% died during 5 years follow-up. A mortality prediction model was developed using 94 candidate variables, distilled into a life expectancy model with 11 input variables, and transformed into a risk-scoring tool, the Life Expectancy Estimator for Older Adults with Diabetes (LEAD). LEAD discriminated well in the test set (C-statistic = 0.78), 2010 cohort (C-statistic = 0.74), and 2019 cohort (C-statistic = 0.81); comparisons of observed and predicted survival curves indicated good calibration.ConclusionsLEAD estimates life expectancy in older adults with diabetes based on only 11 patient characteristics widely available in most EHRs and claims data. LEAD is simple and has potential application for shared decision-making, clinical trial inclusion, and resource allocation.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.

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